Body,Affect,and Meaning Making in the Diagnosis of Type 1 Diabetes Mellitus: A Semiodynamic Microgenetic Analysis

Introduction

In its most recent report, the International Diabetes Federation (IDF, 2025) reported that 503,000 new cases of type 1 diabetes mellitus (T1DM) were diagnosed in people of all ages in 2024. The diagnosis represents the beginning of a medical therapy focused on controlling the evolution of the disease and achieving the expected health outcomes. However, international organizations and several studies agree that the treatment of this chronic condition is highly demanding, largely because it is multicomponent and self-administered (Coffen, 2009; Elian et al., 2023; Ortega et al., 2018; World Health Organization [WHO], 2003). Even with the availability of medications, supplies, education, technology and specialized medical care, a significant proportion of patients fail to achieve the expected clinical goals, as shown by recent systematic reviews, meta-analyses and global reports (Boonpattharatthiti et al., 2024; Hafidh & Abdella, 2022; IDF, 2025). Organizations such as the American Diabetes Association have recognized that the diagnosis of T1DM carries psychosocial dimensions that cannot be understood solely from a biomedical approach or through the technical procedures of clinical care (American Diabetes Association [ADA], 2025). The experience of receiving this diagnosis includes feelings of confusion, overwhelm, and worry about the future. It is therefore necessary to approach the subjective experience of those living with a T1DM diagnosis, with the aim of gaining a deeper understanding of what it affectively entails to implement the treatment, expanding upon predominant interpretations that focus mainly on behavioral or rational aspects (Valsiner, 2014).

From a biomedical perspective, the diagnosis of T1DM occurs when the immune system has attacked the beta cells of the pancreas, which are responsible for insulin production (ADA, 2023; IDF, 2025). This chronic condition can lead to long-term complications, such as the deterioration of organs like the kidneys, eyes, heart and feet due to the sustained circulation of elevated blood glucose levels. However, these consequences are often experienced by patients as remote threats, located in the distant future. In this sense, the disease demands greater body awareness and continuous attention to one’s own physiological states and the ways in which they are sensed (Cleves & Ocampo, 2018). Treatment of T1DM, broadly speaking, involves multiple self-administered tasks such as daily insulin delivery (via injections or automated devices), adherence to a healthy diet, regular exercise, constant monitoring of glucose levels, and regular attendance at medical checkups (ADA, 2023; IDF, 2025; Munion et al., 2020; Romero-Castillo et al., 2022; Turton et al., 2023). However, what might appear to be a clearly defined and easily applicable routine from the external point of view of health prescribing, becomes a constant challenge because it demands continuous reorganization of everyday social contexts when associated with feelings of embarrassment or public exposure (Datye et al., 2019; Lv et al., 2021; Raymaekers et al., 2021). In addition, managing blood glucose levels involves avoiding both hypoglycemic episodes and hyperglycemic peaks, which generates persistent feelings of frustration and loss of freedom in many patients (Chatwin et al., 2021; Peter et al., 2023). In this light, it can be argued that the diagnosis of a chronic illness such as T1DM is not merely about identifying an organic dysfunction or initiating a therapeutic intervention. On the contrary, the diagnosis names a condition that profoundly affects how a person can think and decide about themselves, their illness, and the world around them (Bruner, 1990; Janoff-Bulman & McPherson Frantz, 1997; Sontag, 1996). It also allows the diagnosis to be conceived as an embodied reality that reorganizes everyday life (Frank, 2013; Kleinman, 2010, 2020; Kleinman et al., 1978). This makes the experience of diagnosis a privileged space from which to understand, from the internal perspective of those who live with it, how patients experience their condition, as it sheds significant light on the decisions they make regarding their treatment and self-care.

Qualitative research in adult populations has also advanced in describing the lived experience of patients with T1DM (Helgeson, 2021; Overgaard et al., 2021; Walker & Litchman, 2021). For instance, a recent systematic review and meta-analysis aimed to understand how adults experience the diagnosis and the phenomena associated with the early process of adapting to life with diabetes. Its findings identified recurrent themes such as initial disbelief, the process of learning about the disease and self-management, the emotional impact of the diagnosis, the need to integrate the illness into one’s personal identity, the reorganization of everyday life and social roles, the role of family and social support, and the importance of connecting with others living with T1DM (Due-Christensen et al., 2018). A predominant methodological trend in the research has been the use of thematic analysis. These studies describe how the diagnosis is experienced by presenting stable patterns of meaning. One such example is a study aimed at examining the meaning of diabetic identity in adults. It identified seven themes related to illness, individuation, and culture: willingness to identify, stories of the non-sick, legends of the responsible, a tradition of transformation, sense of similarity, mystification of difference, and diabetes as a unifying social category (Walker & Litchman, 2021). Similarly, another study employing thematic analysis explored the underlying mechanisms of the specific challenges faced by individuals with T1DM in the workplace. The findings revealed that these individuals are caught between two competing logics: the logic of the patient and the logic of the worker (Overgaard et al., 2021). In an alternative line of research, the authors of this contribution have been developing a field of inquiry focused on understanding how embodied meanings emerge, persist, and change in guiding patients’ experiences and decisions in the context of T1DM (Cleves et al., 2024, 2025; Cleves & Ocampo, 2018). In doing so, they have shifted the emphasis from the description of experience -as is common in thematic analyses- to its ongoing configuration (Cornish et al., 2014). This shift entails a theoretical and methodological approach aimed at understanding processes of change and relative stabilization of meaning. In line with this, the present study implements a microgenetic analysis in a novel way. The following section presents the theoretical foundation that supports this approach and enables the reporting of findings from the case of Martha to the scientific community.

Methodology

This study employs an idiographic approach (De Luca Picione et al., 2019; Salvatore & De Luca Picione, 2023; Valsiner, 2024), which emphasizes the singularity of psychological phenomena and proposes an epistemological shift from the traditional paradigm of evidence accumulation toward the development of novel forms of analyses (Branco & Valsiner, 1997; Stavrou et al., 2014; Valsiner, 2022). This perspective holds that deep knowledge can be generated through the intensive study of a single case, situated within a contextual field of relationships and unfolding over time (Yin, 2014; Zittoun, 2016). The epistemological stance asserts that it is possible to identify “general processes within the particular,” as cases reflect the complex interrelation between individual subjectivity and shared cultural meanings (Valsiner, 2014). Accordingly, the case of “Martha” is analyzed based on the assumption that analytic generalizations can be made, which may later contribute to theoretical development through the logical analysis of multiple cases.

Data Generation

Data were produced through six in-depth reconstructive interviews conducted over a period of 1 month and 25 days by the first author. These interviews were designed to capture, in detail, the dynamic processes of meaning-making related to the diagnosis of T1DM (Zittoun, 2006). The interview guide was validated by an expert researcher with over 25 years of experience in the field (Cornish et al., 2014; Packer, 2018). This validation ensured its appropriateness for a microgenetic approach focused on the analysis of a single case (Reho & Salvatore, 2024). To guide the generation of data and ensure its theoretical and methodological relevance, the interview guide was structured around five analytical axes (Zittoun, 2009). Table 1 presents these axes, along with their specific objectives and their articulation with the microgenetic analysis.

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Table 1.

Analytical Axes of the Reconstructive Interviews: Objectives and Connection With the Microgenetic Analysis

Analytical axes	Objective	Link with microgenetic analysis
Context and rupture resulting from the diagnosis	Explore the initial symptoms, perceptions, contexts and interpersonal relationships that emerged prior to the diagnosis	Identification of initial signs and incipient configurations of meaning that surround and precede the reception of the diagnosis
Moment of the diagnosis	Investigate the affective, bodily and symbolic experience of the diagnosis	Detection of significant ruptures and abrupt reorganizations in the experiential field
Tensions and immediate changes in the experience	Identify the initial processes involved in understanding the diagnosis and self-care	Detection of early interpreters that guide the stabilization of meaning
Processes of adaptation and understanding of care	Understand the changes that occur in daily life, including with respect to the individual’s relationship with treatment and the significance of the diagnosed body	Follow-up of the process of stabilization and cognitive, affective and corporal transformation of the self
Projection and decisions about the future with the condition	Analyze vital projections and the meaning attributed to the experience of the disease and the diagnosis	Identification of processes of meaning construction and signs that guide future meaning

Results

The case of Martha is presented and analyzed through four key moments in the configuration of meanings around her diagnosis: (1) the transition toward illness, (2) receiving the diagnosis, (3) the search for healing, and (4) the embodied experience of a hypoglycemic episode.

(1) The road to diagnosis: Martha “earns the diabetes”

The reception of the T1DM diagnosis is preceded by a context marked by significant social relationships and life transitions. The first relates to the shift from private to public education. During high school, Martha attended a private, all-girls school, characterized by structured routines. This environment, which was characterized by stability and order, stood in contrast to the public educational system that she subsequently entered: a space for men and women with diverse socioacademic backgrounds that features an infrastructure that Martha perceived as disorderly (Quote 1). In this context, Martha indicates that she spends time “obsessing over” her academic performance. This reference to obsessing suggests that she experiences this situation with guilt, thus anticipating the development of diabetes (Quote 2). However, notably, this situation is not limited to the fact that she has developed an obsession. That is, the use of a term should not be confused with the full meaning that the situation offers in this context. Rather, Martha faces a significant change in her position within a new relational system (mainly with respect to her peers). Similarly, she occupies the position of a “facha” among her peers (Quote 3). Being “facha” is a local term associated with upper-class status, refinement, or being ‘too posh’. That is, she becomes positioned as different, occupying a socially advantageous place from which it may be difficult to establish relationships with her classmates.

Quote 1: “I saw the walls, the nature, the… well, I didn’t really see it, I mean, I could see that everything was just too relaxed, and I was all tense, so instead of enjoying the environment or going ‘oh, how nice!’, it was more like, like a shock”.

As Martha undergoes this transition, her personal notion of ‘order’ is brought into question. The contrast between the ‘order’ she associated with her former school and the ‘disorder’ she perceives in the university setting not only reflects her discomfort with the new environment, but also reveals an ongoing process of self-understanding (of where she comes from and who she has been) through which she seeks to reaffirm her identity in relation to others (Quotes 1, 3, and 4).

Quote 4: “Suddenly entering this university, the disorder (emphasis), the filth”.

Within this relational and affective context, Martha situates the emergence of her diagnosis. The way she narrates the shift in routines between school and university is marked by emotional intensity, evident in how she elongates certain words and emphasizes others (Quote 5). At the same time, her account shows how changes in certain practices are configured in relation to other people (such as her engagement with coffee, cigarettes, and staying up late). Affective expressions emerge in various forms. In terms of guilt, for instance, this is reflected in the way she refers to these practices as ‘vice’ rather than simply habits (Quote 6). Feelings also manifest as a sense of losing control—both over herself and the demands of university life—as she puts it: ‘I became incredibly disordered.’ At the same time, they appear as part of a struggle, in which the body becomes the medium for an intense practice, namely, reading

Quote 5: “I neeeever, neeeeeever in school—even though it was demanding—I had never stayed up late at night for school, never. I was seventeen, no, I had never stayed up late in my life” (emphasis on the first syllable of life).

Now, when Martha says, “maybe this is how they manage to endure the reading”, a meaning-in-absence is implied: the “they”: those who can endure it. It is important to consider that in her field of study, reading is not only a demanding academic task but also a key practice for participating in the academic community. As such, it becomes a desirable activity that enables a sense of group belonging and identity formation. Therefore, coffee, staying up late, and smoking are not merely inadequate or unhealthy strategies for coping with academic demands. They are also signs expressing a need to belong to the group and, at the same time, a form of resistance to external pressures (Quote 7). In this process, the body operates as both a limit and a medium through which these tensions become inscribed and shape experience. Nevertheless, even though the situation involves all these elements, Martha seems to locate the cause of her diagnosis within herself (Quote 8). There is a process in which she assumes, with a sense of guilt, that she earned diabetes as a consequence of an ongoing inner struggle, as well as changes in her habits and routines (Quotes 2, 3, 8, and 9):

Quote 8: “I earned the diabetes from all that fighting, I think”.

This case illustrates a situation in which, despite the presence of a meaningful narrative that connects various events, reflects upon them, and communicates them in an articulated way, the process of signification remains open and unfinished (Quote 8). This becomes more apparent when comparing the meaning-in-presence—“I think”, which conveys probability—with the meaning-in-absence: certainty.

(2) “Already too diabetic to turn back”: The three hundred and eighty of the diagnosis

Martha’s case shows that receiving the diagnosis does not operate merely as the transmission of medical information to be rationally processed or understood. Rather, it emerges as a meaningful event that entails a reorganization of experience. This moment can be understood as a point of collision, convergence, and tension among meanings that will later, as we will see, be reconfigured and stabilized—allowing Martha to make decisions regarding her treatment, even privileging the expert knowledge of health science (Quote 20).

Quote 10: “So, anyway, they ran the tests—three hundred and eighty blood sugar (tone of astonishment)… through the roof, I was already, already way too far gone, way too far (tone of strain), diabetic with that three hundred and eighty”.

The expression “way too far gone” (Quote 10), uttered with a tone of astonishment and strain, gives rise to a strong meaning-in-presence—namely, the number “three hundred and eighty” that follows. Taken outside of an interpretive relationship, as if the sign carried meaning in itself, the signification would point merely to an abnormally high blood glucose level. However, for Martha, the number becomes a sign that reorganizes the meanings associated with the body—now marked by a difference that no longer allows a return to a state of health. Here, the number functions as a sign that delineates a before and an after. Moreover, it reconfigures what it means for her to inhabit her body—not merely as someone who had been experiencing symptoms and feeling unwell, but now as “a diabetic person”. The situation becomes more complex when considering the temporal coincidence with her birthday (Quote 11), which introduces a tension among three simultaneous meanings: the celebration of life, the beginning of an altered life, and the beginning of an altered life at a moment symbolically charged with future projection and autonomy (at 18, the age that marks legal adulthood in Colombia). The affective tone —marked by crying and the emotionally emphasized phrase “everything was the last”—suggests an affective operation that mobilized her experiential field. Provisionally, Martha found herself in a position of imminent loss and closure of possibilities: sugar, champagne—that is, everyday pleasures—as well as restrictions on movement, agency, and decision-making in the world, all of which are typically associated with reaching adulthood.

Quote 12: “(…) but I never imagined it was my last time not having to, that from that moment on I would have to inject myself for the rest of my life”.

Martha’s case illustrates the emergence and gradual stabilization of meanings that unfold over time. Although there is an attempt to assimilate what she has experienced, the body has not yet been fully integrated as a diagnosed body (Quotes 11 and 12). Later, meaning-making gives rise to implications regarding the lifelong need for injections, which entail a redefinition of both the body and everyday life (Quote 12). Eventually, a certain stabilization of the experience becomes visible, as a process of meaning construction takes place in which Martha connects past events and develops an explanation—framed in terms of adaptation—to convey her experience of living with Type 1 Diabetes (Quote 13). A notable aspect here is that Martha turns to a general category: not that of herself as a person, but of herself as a human being. That is, she appeals to a broader symbolic framework, possibly to reduce the sense of exceptionalism tied to her individual condition and to elaborate a viable way of coexisting with the illness.

(3) The hope in pancreatic recovery

Following the diagnosis, a reorganization of Martha’s field of meanings emerges, orienting her actions toward the search for a cure with the aim of returning to a pre-diagnostic state.

Quote 14: “I tried several things to make my pancreas work the way it used to before”.

This search appears as an active meaning-making process in which Martha reinterprets what it means to inhabit an altered body. The expression “make my pancreas work the way it used to” suggests that the pancreas functions as a condensed sign of non-normality: not only in its physiological role of secreting insulin to regulate blood glucose levels, but also as a representation of a way of life that Martha wishes to restore (Quote 14). This attempt at restoration is enacted through actions guided by an affective and symbolic logic of dietary detoxification, seeking to reintegrate the body within a network of meanings that allow her to feel like someone who can once again be “healthy” by being “non-intoxicated” (Quote 15). The strength of this emerging meaning is such that it transforms her eating practices to the extent that Martha relinquishes pleasurable sensory and bodily dimensions (Quote 16).

Quote 17: “It was like my first hospitalization related to diabetes (‥) and I got a terrible scolding from the doctors, like how could I even think that, and everything—like that’s when I understood a bit how the whole insulin dynamic worked in relation to what you consumed”.

The process of seeking a cure begins to reveal to Martha how the illness functions, particularly after undergoing a personal crisis that involved hospitalization. This moment represents a turning point, partly due to the reprimand she receives from the healthcare staff, but more importantly for two key reasons. First, it constitutes a novel experience for her, for which she has few prior meaning structures to stabilize or anticipate what is happening. Second, it initiates a cognitive process of meaning-making, involving the association between insulin and food intake (Quote 17).

Quote 18: “and I’d go bam! I would hold on with faith and then let go and say, ‘oh, I don’t believe in this either anymore!’”.

Later on, Martha’s case illustrates the coexistence and tension between biomedical knowledge and other forms of understanding the illness, which she refers to as “esoteric” (Quotes 18, 19, and 20). The oscillation between “holding on with faith” and “letting go” (Quote 18) enacts a dual affective semiosis, in which meanings alternate between hope and hopelessness and are reformulated over time, ultimately enabling Martha to reach a more stable decision regarding treatment (Quote 20). Her use of the expression “most definitely” (Quote 19) conveys not only empirical certainty but also an affective mark of disillusionment, in which the idea of a cure—conceived as an absent sign—loses plausibility. Due to space limitations, we cannot fully analyze the entire process of Martha’s search for alternative treatments. However, we can show that this search leads to greater proximity to biomedical knowledge and contributes to a more stable experience of illness. Rather than a complete rejection of the meanings associated with what she calls “the esoteric things”, this dimension becomes complementary to formal medical knowledge—not as a path to healing, but as a way of connecting with broader dimensions of existence (Quote 20).

(4) The experience of the “downer” and the opening of the pores

The crisis triggered by a hypoglycemic episode illustrates how Martha gradually constructs the semiosis of insulin and the diagnosed body. This crisis revolves around a sweet food she particularly craved—specifically, a turrón (nougat).

Quote 21: “So I said, hmm, I usually inject eight units and eat no sugar, so in order to eat a piece of that really sweet turrón (nougat), hmm, I think I need to inject around ten units”.

Martha constructs a creative negotiation in which she transforms the meaning of insulin administration prior to the crisis. It ceases to function solely as a medical regulation tool and becomes a sign that articulates her agency in response to normative care demands. Rather than adopting a dichotomous logic of obedience or disobedience, increasing the insulin dose before eating the nougat allows her to experience a sense of freedom in her decisions without fully breaking away from the constraints of her condition (Quote 21). This reconfiguration introduces novelty into the process of semiosis, as it momentarily alters the interpretive framework through which Martha organizes her experience. It opens a space of possibility in which her desire for freedom is not experienced as an absolute rupture. In this way, she actively appropriates the demands of her illness. During the crisis, by contrast, Martha’s experience reveals a disruption in her sense of agency as it emerges from the body. The phrase “it wasn´t responding” suggests a perceived distance between her identity and her body (Quote 22). Insulin mediates this relationship and acquires a meaning that places tension on her identity—positioning her simultaneously as a patient who seeks control and freedom within her own body, and as a person who must respect the administration of the hormone (Quotes 22 and 23). Following the crisis, Martha’s case reveals a dual meaning of respect and fear toward insulin. The expression “My God, what a horrible thing I felt!” illustrates how insulin temporarily becomes an object of fear (Quote 23).

Quote 24: “I had already injected eight units in the morning, then I injected ten units, and it was around eleven in the morning. What do I remember? That I was, uh, lying down, I was lying down, watching TV, and suddenly, of course, the insulin peak from eight o’clock coincided with the downer”.

Martha’s experience illustrates the embodied unity of cognition and affect. As can be seen, she uses technical and procedural language to describe the calculation of insulin doses and their bodily effects. She organizes this experience around temporal and causal elements, which enables her to construct meaning from the crisis event (Quote 24). At the same time, this calculation is infused with affective experience. She not only reconstructs the episode but also resignifies it as a form of learning about her body and the illness. In this way, her understanding of “peaks” and “downers” becomes a foundation she can eventually draw on to manage diabetes in the future. Moreover, the case also reveals the intensity of affect as expressed through bodily terms: the profuse sweating and the sensation of her pores opening up become signs of exposure and vulnerability (Quote 25). It is as if the body were speaking and being interpreted by Martha, forming a bridge between what is lived and what can be represented through communication and thought. If the body functions as a point of mediation between the self and the world, the opening of the pores might signify a moment in which the boundaries between the internal and the external are perceived as more porous, intensifying the connection with both dimensions. The intensity of affect, evident in the words she chooses (“buckets,” “every single pore”), operates as a sign that expresses, articulates, and organizes her perception of the crisis (Quote 25). In this sense, affect is not merely a reaction to the biological effects, but a force that mediates Martha’s relationship with her body, her treatment, and her sense of self in relation to the world.

Discussion and Conclusions

This study contributes to an emerging strand of qualitative health research concerned with how the body operates as an active source of meaning in the specific context of adults diagnosed with T1DM. This perspective remains largely underexplored in relation to this chronic condition and opens new pathways for analyzing the diagnostic experience beyond thematic descriptions or representational frameworks of meaning-making. The discussion has been structured in three main dimensions. First, the moment of diagnosis is presented as a life-altering event that involves a symbolic reconfiguration of personal experience. Second, the lived body and affective dynamics are shown to operate as active forces in the organization of meaning, particularly through hypoglycemic episodes. Third, attention is given to the processes through which meaning becomes relatively stabilized over time and how this affects the ways in which individuals manage and care for their illness. This analytical strategy makes it possible to return to the research question, which sought to understand how meanings about the diagnosis of T1DM emerge, transform, and stabilize.

The moment of diagnosis is often regarded in clinical practice as the formal entry point into therapeutic intervention. However, in Martha’s case, it does not merely label a biological alteration; rather, it involves a reorganization of what the diagnosis comes to mean for her, based on what she feels and notices in her own body. This case illustrates that, initially, there is only a partial integration of the diagnosis as something meaningful, which nonetheless triggers an intense emotional response (crying) and a sense of loss regarding pleasurable elements (such as sweet foods and alcoholic beverages). Subsequently, driven by an active search for a return to her previous state of health (the desire to reverse the illness by restoring pancreatic function), she experiences a hypoglycemic crisis that contributes to stabilizing the experience of the diagnosis. This occurs by enabling her to grasp how the treatment works and what it personally entails to endure a severe hypoglycemic episode. Following this, the process of meaning-making leads her to opt for a form of treatment more aligned with biomedical knowledge. This finding resonates with the notion of rupture, according to which destabilizing events such as disease diagnoses interrupt ongoing processes of meaning-making and demand the construction of new symbolic mediations, learning processes, and resources (Zittoun, 2006, 2023). Similarly, it echoes the understanding of illness as a moment in which individuals lose both the “map” and the “compass” that once oriented their lives, facing problematic situations related to desire and control (Frank, 2013; Kleinman, 2020). However, what this study adds to previous work is a more detailed account of the temporal unfolding of meaning, allowing us to observe that receiving a diagnosis does not operate as an immediate or univocal symbolic act, but rather as a semiotic chain whose effects develop over time.

Hypoglycemic episodes, in turn, trigger more lasting reorganizations of meaning. The intensity of these episodes leads the patient to re-signify her treatment, not only through external instructions on how to manage her illness, but through a felt, embodied experience that imposed itself as meaningful, thus turning the body into an active semiotic field. This finding aligns with a previous study in which the authors reported to the academic and scientific community that the initial sensation of physical distress -that is, the critical drop in blood glucose levels- serves as a starting point for a meaning-making process that extends to core aspects of the individual’s life. Moreover, the hypoglycemic symptom, understood as a set of experiences capable of destabilizing the subject, should be considered in evaluating how one’s sense of self is affected (Cleves et al., 2025). The analysis of hypoglycemic crises in this case also resonates with semiotic approaches that emphasize how signs are integrated within sign networks and acquire transformative functions with respect to the ontological status of objects (Tateo, 2018, 2024). However, the present case adds a bodily dimension that is often absent from such accounts, allowing for a better understanding of the transformative power of bodily signs. In this sense, the case illustrates that hypoglycemic bodily signs are not neutral alarms; rather, they reorganize the connection to and sense of agency one feels with respect to the body, while also transforming the meaning of insulin-based treatment; imbued with both respect and fear. From the perspective of the semiodynamic model, this moment exemplifies the tension between Signification in Presence (the immediate and pressing need to interpret the hypoglycemic crisis) and Signification in Absence (what the bodily crisis means to the subject and how it gradually shapes their perception of the future). Understanding signification in this way makes it possible to see how it becomes a vector that guides treatment decisions beyond the mere avoidance of physiological alarm states (Salvatore et al., 2024).

The progressive stabilization of meaning around the diagnosis is particularly illuminating when contrasted with many qualitative studies that tend to organize patients’ experiences through relatively fixed themes or narrative typologies, such as those of restitution, chaos, or quest (Due-Christensen et al., 2018; Frank, 2013; Helgeson, 2021; Overgaard et al., 2021; Walker & Litchman, 2021). While these approaches have been valuable in making patients’ subjectivity visible, they may also produce a static image of meaning by failing to adequately address how meaning is dynamically configured through the body and affect in concrete situations. Similarly, some works have proposed that the social metaphors circulating around illness -though embodied and affectively experienced- tend to shape the experience from the outside, often simplifying or stigmatizing it (Sontag, 1996). In contrast, the microgenetic analysis of Martha’s case demonstrates that meanings are not passively imposed, but are actively reorganized through embodied experience. In this process, hypoglycemia is configured as a loss of personal agency and a dissolution of the boundaries between body and environment, producing a sense of vulnerability that grounds new understandings of the body. Once this meaning becomes consolidated, it begins to guide practical decisions related to treatment. That is, such stabilization allows for greater structuring of the experiential field -yet remains dynamic- making it possible to evaluate specific treatment options (such as insulin patches or sublingual insulin) as viable responses to perceived fragility. In this way, the stabilization of meaning organizes experience and configures the horizon of possibilities from which a person decides, acts, and relates to their illness.

It is important to highlight that the proposed analysis opens new pathways for qualitative research in health, especially when the aim is not merely to document suffering or adaptation to illness. The findings suggest that a person’s actions in relation to their diagnosis and treatment -what they do, avoid, or prioritize- are semiotically mediated by a dynamic and embodied network of meanings. In this sense, the microgenetic approach enables a processual understanding that may enhance the sensitivity of clinical practice, allowing professionals to better recognize moments in which interventions resonate affectively, or in which symbolic reorganizations are taking place beneath the surface of observable behavior (Munion et al., 2020; Romero-Castillo et al., 2022; Turton et al., 2023). The analytical tools used here may be adapted to other chronic conditions that require constant bodily attention, affect regulation, and ongoing social negotiation. From a clinical perspective, rather than attributing non-adherence or lack of engagement with treatment to informational deficits, these findings invite greater attunement to the ways in which patients are immersed in dynamic fields of meaning that shape what feels possible, desirable, or threatening in relation to the diagnosis and its treatment (Lv et al., 2021; Raymaekers et al., 2021). Finally, these results must be considered in light of their scope. By focusing on a single case, the study does not aim to represent the full range of possible experiences in T1DM, but rather to offer a precise and in-depth analysis of a singular process. Nonetheless, the analytical density afforded by the microgenetic approach offers a pathway for the progressive construction of theory, by generating interpretive hypotheses that may be explored in future research, whether through additional case studies or through comparative analyses of other systematically documented cases. Furthermore, longitudinal studies -including the precise moment of diagnosis- are needed to observe in greater detail how the meaning of the diagnosis is initiated and transformed over time. In this regard, a fertile field of inquiry remains open for qualitative health research to provide a richer understanding of how the meaning of diagnosis evolves in patients’ lived experience.